EDITOR,--We believe the editorial on managing cleft lip and palate to be misleading.1 The Eurocleft study indicated that the outcome of repair of cleft lip and palate was inversely proportional to the number of operators.2 To suggest that cleft surgery services should be devolved to local hospitals with multiple operators undertaking few procedures therefore seems illogical and is also at odds with the situation in continental Europe, where cleft surgery is concentrated into a small number of centres.

Anatomical specialisation seems logical, but the suggestion that high volume operators in adult maxillofacial …